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12011, that's the high point. you could have picked any other point and they could have been increased if they could have picked q 2, 2010? >> yeah. but if you would draw a line particularly since quarter 2009. it has been pretty stable. yes, you are right but we did have a dry point to reflect a change in population as well as a change in activity to justify the cost. >> okay. thank you. >> on page 20, the city plan per thousand has decreased 10

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percent since 2 years ago. again, that was the high point that we picked. what we are doing if you will looking at the 96 per thousand kaiser 464 at the in point at 62.7. if you noticed as i mentioned earlier, the city plan is not that different in age and male female distribution. so you will notice that the factor one is much closer at 93 percent. you would not expect to see much changes. if you notice the average length of stay is at

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5.9. there is about 1.75 spread between high and low and the blue line of skilled nursing is the most variable of them all of moving on to the cost per day, what you will notice is the current inpatient cost per day is about 62.43. it's an annual cost of 2.5 years. this is not unexpected and quite reasonable trend for this period of time. moving on to page 23. there is nothing as you look at the graph and you will see it pretty flat. the only thing to draw out here is that the growth is about 1.3 percent. there is a slight growth in er rate of 4.6 percent and surgical cost and yet nothing above trend. lastly looking at the procedures per thousand, again, we have the

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issue of the other 21,000 of the 33778 are other. and we have to work with uhc to see what goes into that very low dollar area. in the generic drug dispensing is 77 percent. pat yourself on the back. this is a 48 percent increase in dispensing. you've almost doubled it. good job. as far as cost goes, they have gone down which is what you would expect to see in shifts in increase and shifts to generic. the cost per script has decreased 14.9 percent to 104.53 in quarter

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two. you have the same types of drugs in the actives, however the diabetic increases are in creasing in dollars. in summary what we'll bring to you is information to consider. the city plan's healthful and sustain able retirees. it's not sustain able as it is. we recommend the hs board consider several options for the future of the active and early retiree pool. one is move the pool with medicare retirees. the second would be to close the active city plan to all employees other than those outside the

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kaiser and blue shield service areas such as the heche but very small. third we ask and investigate the policies to make the changes to the active plan to draw more people into it to make the plan affordable again. howevercious that does have a down side that it might cause increase rate in population which is a higher volume than the uhc plan. what i want to say these are the consideration we have and they can all concur as individuals or in groups of two or three of the options if you want. so with that, i would entertain any questions that you may have. >> mr. scott? >> i wanted to go back to your slide 26. you identified for early retirees with diabetes is kind of a therapy that is

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impacting cost. are you seeing a similar trend around the things around cardiovascular disease related issues? >> when i looked at the top drugs i did not see a repeat, you have the stat ins but because of diabetes you have the insulin that is not all generic and that's where the cost accrue. >> they are present in this? >> they present but not enough to overall impact your drugs >> over time we should be able to anticipate that that would be kind of an outgoing outcome with this population. >> as the population ages one would see cardiac increases. >> all right. so these are

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three suggestions that everyone take a look at for some other meeting? >> exactly. >> thank you for your presentation. >> could we take a short break at the request of the board members. >> thank you so much. >> 10 minutes.@@úúúúppxxxx÷÷ >> i'm asking for public comment on no. 10. item 11. any

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discussion. >> item 12. item to put items on future agenda. >> any public comment on this item? >> sorry. i don't understand. still working on this. >> commissioner fraser. wiener and mar.

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>> my suspicion is that it will take a while and whose bill it will make it out. to be clear, it's nothing but unclear now. i will keep everyone updated for sure. >> all right. item no. 13. >> the clerk: item 13, discussion item, opportunity for the public to comment on any matters within the boards jurisdiction. >> commissioners, just one quit note while i'm not hard of hearing is that you don't speak directly into the microphone and especially commissioner fraser, we can rarely hear almost all of what you say and it gets lost and you swallow the end of your sentences. after many years. too many years of speech and forensics.

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commissioner, it's great because we hear everything that you say. i would ask you all to please speak directly into the microphone. we have members who regularly wear hearing aids and we have difficulty understanding what goes on and the commission secretary is right on with her comments. everything she says can be heard. thank you. >> thank you. >> commissioners, dennis krueger active and retired firefighters. on behalf of the firefighters i would like to say hello to catherine and hope that you will all our prayers are going well for you. i have heard a couple things today that kind of fall into that

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wheel house. supervisors of san francisco have passed a wellness resolution. i think that's wonderful. they are doing research into transparency and cost and hospitals. one of the things that comes up is causes of waste is inadequate primary and preventative care and that's what i'm here to talk about. dental. the most basic preventative care that we have in our society. and our dental program lacks. specifically among retirees who need it the most. i think of a wisdom tooth that gets infected and a person that can't pay or hasn't got the money to have it taken out. that leads directly to heart disease. what is cheaper to

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abstract an abscessed tooth or have a heart operation. preventative care includes dental. so i'm looking forward to work with lisa, the deputy director regarding looking into our dental plans and hopefully at least bring retirees up to what the active people are receiving and hopefully increase that for everybody. i was in europe earlier this year, i cracked a tooth. i went into a dentist in switzerland, he looked at it, checked it out and told me what to do and i went in for a price, don't worry about it. it's taken care of. almost every health plan in europe of the industrialized nations there include dental. if we want to make people healthier, we have to improve

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their dental. thank you. >> thank you. any other public comments. no comments? item no. 14. >> the clerk: item 14, action item vote on whether to hold closed session to discuss the members appeal has been canceled, so member account overpayment. president? >> all right. i will need a recommendation. >> i move we go into closed session to discuss the item referenced. >> second. >> okay. any public comment on this. all in favor say, "aye". >> aye. >> all those opposed? right. we'll now be in closed session.

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disclose information regarding machine account overpayments. >> i move that we do not disclose member information. >> second. >> all in favor say, "aye". >> aye. >> opposed? okay. now we have no. 18. >> the clerk: action item, possible report on action taken in closed session regarding member account overpayments. >> all right. all in favor say, "aye". >> aye. >> opposed? all right. if without any objection, this meeting is adjourned.